Jul 12, 1998 03:00 AM

Introduction

A person may have a variety of reasons for wanting to stop taking psychiatric medication. He or she may want to be free of the dulling effect that most psychiatric drugs cause or of more serious side effects that he or she may be suffering. The person may be worried about the long-term effects of the drugs, including tardive dyskinesia (involuntary muscle movements). Or he may be wanting to make a major change in his life by freeing himself from a dependence on powerful medication. 

Whatever the motivation, the person has a right to free himself from using medication. There may well be situations in which others don’t agree with a person who wants to stop taking psychiatric medication. They may be scared that doing so will do the person serious harm. But it is the individual’s right, and he probably has sound reasons for wanting to stop using the drugs. After all, he is the one who has to live with the consequences of the medication, and he is the only one who knows how the medication really affects him. 

You can support him by helping him make informed choices about his options. You can give him information about his medication and its effects. You can also give him information about getting off the drugs, and you can support him in carrying out his choice in a safe way. 

That safety may be the most important support that you can provide. Remember, you have little influence over what he does after he leaves the transition house. He may stop his medication cold, without information or support, and put himself in serious danger. 

The symptoms of too-rapid withdrawal from psychiatric drugs include extreme nausea, anxiety, insomnia, restlessness, muscular reactions, and strange behaviour. In the case of minor tranquilizers and sedatives, the reactions to sudden withdrawal can be life-threatening.  You can support him in struggling with these issues and making an informed choice. But remember that you are dealing with something that is his right. If you pass judgment on his wishes, you won’t be helping him find out what is really best for him. And he may simply stop his medication anyway, without the information and support he needs. 

Finally, a person who wants to stop taking psychiatric medication should have the support of a sympathetic doctor. By sympathetic we mean a doctor who is willing to accept a person’s right to choose his own path and work with him on getting off the medication. This is the best way, to have the active involvement of a doctor who can help plan and monitor a person’s withdrawal from psychiatric medication. 

Note that many detox centers and drug abuse programs help people to stop taking minor tranquilizers and sedatives, but not neuroleptics and antidepressants. 

What follows is an overview of the basics. It will help you or people you work with understand what’s involved in the process and how one goes about it.

The Basic Principles

There are some basic principles that a person has to follow to stop taking psychiatric drugs safely. Familiarize yourself with them, and make sure that any person you work with who wants to stop her medication is familiar with them, too. 

• Don’t try to stop taking psychiatric drugs without support. 
• If at all possible, find a supportive doctor to supervise the process. 
• Never stop taking psychiatric drugs abruptly — going “cold turkey” can   lead to serious withdrawal symptoms and can be life-threatening. 
• The best way to stop is to reduce the dosage gradually; by withdrawing gradually and carefully it may be possible to minimize withdrawal symptoms. 
• Withdrawal from sedatives and minor tranquilizers can be extremely dangerous. 
• Withdrawal symptoms don’t necessarily start immediately; they may begin anywhere from 8 hours to several days after quitting. 
• The time it takes for withdrawal symptoms to set in and their severity varies from person to person, and depends on how long you have been taking the drugs, your dosage, your overall health, your body weight, and so on. 

Steps to Follow

1. Find a supportive doctor who will work out a withdrawal schedule with you and monitor your progress. You may be able to find one in the AlternativeMentalHealth.com directory. Or other psychiatric survivors or a survivors’ group might be able to suggest a doctor. 
2. Have a living situation that is as stable as possible. 
3. Organize support from friends, family, survivor groups, local organizations and/or any other source of help. 
4. Withdraw from the drugs as gradually as you can. A common method is 10% per week. 
5. Find out as much as you can about the process so that you will be prepared for the withdrawal symptoms. 
6. Don’t expect to feel much difference in the first few days. 
7. Realize that your body and mind are going through a difficult experience. 
8. Make sure you get enough sleep. Difficulty in sleeping is a common problem; it’s important that you get at least 6 hours of sleep a night. Use herbal remedies for sleep, and try massage, etc. But if nothing else helps, it’s worth taking sleeping pills just for this short period. 
9. Stop using stimulants like coffee, sugar, chocolate, alcohol, or street drugs. 
10. Eat the healthiest diet you can to help your body purify itself. Vegetables, fruit, nuts, and grains are important; eat as little red meat as you can, and avoid junk food. 
11. You will have more physical energy as your body gets away from the drugs. Exercise will help you stay calm, and will be very helpful if your energy seems to be getting out of control. Try to start exercising, swimming, hiking, or bicycling. But start gradually. 

Setting a Schedule

Remember, psychiatric drugs should never be stopped abruptly! The more slowly you can withdraw, the less bad effects you will suffer. The best plan is to work out a schedule with your doctor that best suits your situation. 

Standard practice is to reduce your dosage by 10 percent per week, monitoring your progress at every step. The first week, you would reduce your dosage by ten percent. Try that for the first week, and then see how you are doing. If you feel OK, reduce the dosage by another 10 percent. Try that for a week, and see if you feel OK. 

If you reach a point where you don’t feel OK, don’t reduce your dosage by another 10 percent. Stay at the same reduced level for another week or until you do feel fine. Then reduce by another 10 percent and continue with the process. Some steps might be more difficult than others; take your time. For example, if you are taking 200mg of Chlorpromazine a day, reduce by 10 percent — 20mg — to 180mg per day. Try that level for a week. The next reduction would be to 160mg a day for a week (or longer), then 140mg a day, and so on. 

If you are taking more than one medication at a time, it’s best to stop them one by one. If you are taking a neuroleptic (major tranquilizer) and an anticonvulsive drug (anti-Parkinsonian) at the same time, which is common, withdraw from the neuroleptic first. However, if you are taking more than one medication, this is a situation where it is definitely best to have a doctor working with you. 

Withdrawal Effects by Drug Class

If you are working with a person who wants to stop taking psychiatric drugs, it’s important to be familiar with the typical reactions or symptoms of withdrawal. These vary, depending on the person, how long he’s been taking the drug, his dosage, and the type of drug. 

Different classes of drugs bring on different withdrawal reactions. Some of these reactions may be disturbing and hard to witness but not really dangerous. Others may be life-threatening. 

A familiarity with drug withdrawal reactions will help you in working with anyone who is taking psychiatric medication. Many patients don’t take their medications as prescribed; they will alter their dosage, increasing or decreasing the amount they take. Or they will miss a day’s medication, and then catch up by taking twice as much the next day. By mistakenly taking too little medication, they may bring on the early stages of withdrawal. Mysterious physical and emotional complaints may actually be signs that they are not taking their medication as prescribed. 

Even when a person is taking his medication as prescribed, he may experience the beginnings of a withdrawal reaction as a dose begins to wear off.  For example, a person who is taking a minor tranquilizer may find himself feeling agitated and restless before he is to take him next prescribed dose. 

In both cases, these signs are the results of the early stages of withdrawal. It may seem like the agitation, anxiety, or physical discomfort are signs of a person’s “mental illness” or a sign that he really does need the medication he’s taking. However, his complaints may actually be due to the physical effects of the beginning stages of drug withdrawal. 

Listed below are the main classes of psychiatric medication, along with the withdrawal reactions that are most common with each of them. 

Antidepressants and Neuroleptics

· flu-like syndrome with headache, muscle aches, chills, nausea, vomiting, diarrhea, and loss of appetite 
· muscular reactions such as uncontrollable rhythmic movements and tremors (these are more severe with neuroleptics) 
· insomnia, emotional distress, feeling like one is “going crazy” 

Lithium

· less side effects generally than other classes 
· insomnia, anxiety, irritability.

Minor Tranquilizers, Sedatives

· sudden withdrawal can result in life-threatening seizures; withdrawal must be very gradual 
· seizures common in early stages of withdrawal 
· other reactions can include flu-like syndrome (see above), muscle tics, restlessness, and anxiety 
· withdrawal symptoms usually take a few days to develop, but can occur immediately and get worse during the first week.

What You Can Do to Support a Person Withdrawing from Medication 

1. Respect the person’s right to make his own choices. 
2. Be informed about the process of withdrawing from psychiatric drugs. 
3. Be familiar with the withdrawal symptoms so that you can stay clearheaded and not panic. 
4. Realize that people who disapprove of what the person is doing may want to interfere with the process. Be prepared for that. 
5. Remind the person to get enough sleep. 
6. Make sure he gets enough to eat. Help him prepare food, as he may be too nervous to cook on his own. 
7. Help him get in touch with other people who will support him. 
8. Don’t be misled by the withdrawal symptoms, thinking that they are signs of his “illness.” Be patient; it takes time to withdraw from the drugs and adjust to life without them. 

The information of this Website is for educational purposes only and is not intended to replace the advice of physicians or health care practitioners.  It is also not intended to diagnose or prescribe treatment for any illness or disorder.  Anyone already undergoing physician-prescribed therapy should seek the advice of his or her doctor before reducing the dosage or stopping such treatment.